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UNC CH HEALTH SCIENCES lIBRAR'
H00159013 J
SECONB
OF THE
NORTH CAROLINA
tl!: BOARD OF HEALTH.:
1S8S.
Ct)e Hibrarp
ottt>t
Dtt)i0ion of lj)eau!) affairs
Onitjewitp of Jl^otttj Carolina
I
-J,
a day
SMGND BlENN'IAIi RBP0RT-OF
THE
North Carolina Board of Health
TO THE
GENERAL ASSEMBLY OF NORTH CAROLINA,
SESSION OF 1889.
RALEIGH :
JosEPHUS Daniels, State Priuter and Binder,
Presses of Edwurds & Broughlon.
1889. ^ ,q
u
i>iu. W. D. Billiard, Mr. J. L. Ludlow, C. E.
Illuminating Oil Prof. W. G. Simmons.
Climatology Dr. J. W. Jones.
Adulteration of Foods and Medicines Drs. McDonald and Tucker.
Sanitary Condition of State Institutions Drs. Lewis and Jones.
Vital Statistics Drs. Wood, Lewis, Bahnson.
SECOND BIENNIAL REPORT
OF THE
North Carolina Board of Health.
REPORT OF SYNOPSIS OF WORK DONE BY THE
NORTH CAROLINA BOARD OF HEALTH, MADE
BY THE SECRETARY TO THE CONJOINT SES-SION
WITH THE MEDICAL SOCIETY OF N. C.
Synopsis of Work doxe for 1887-'88.
[Report from Thomas F. Wood, M. D., Secretary of the North CaroHna
Board of Health.]
The work of the Board is still confined to elementary
principles. It was recognized at an early day that eventual
success must be based upon the spread of the knowledge of
hygienic principles, and without this foundation no consid-erable
superstructure could be built.
Mortuary Reports from Toivns.—No better instance of the
slowness of sanitary teaching need be cited than that of the
returns from our towns. Wilmington was, for a long time,
the only one reporting, and it is interesting to recall how
critically the reports from that town were commented upon
by newspapers in non-reporting town?'. The disadvantage
seems to be enough at times to induce the Superintendent
of Health to give up the publication of them ; but time has
shown. the wisdom of persistently giving to the public the
actual state of mortality, both as regards the actual state of
things it portrayed and as an example to the other towns of
the State.
4 SKCONI) I'.IKXMAI. KKPOKT
In November, l.'^SG, we were enabled to publish in the
Bulletin of the NortJi, Carolina Board of Health, the mortality
returns of four towns, viz : Wilmington, Charlotte, Asheville
and Fayetteville, having begun probably in the order of
date as named above.
In the December report, Raleigh was added to the list,
but failing for the next three months to be reported. At the
date of this report there are fifteen towns reporting, viz
:
Wilmington, Charlotte, Asheville, Fayetteville, Raleigh,
Durham, Newbern, Goldsboro, Henderson, Washington, Tar-boro,
Salisbury, Statesville, Oxford and Greensboro. The
basis of these reports is the record of the keepers of
cemeteries, received through the keepers themselves, or
through the mayor of the town, or yuperintendent of
Health, or whoever could be induced to give the state-ments.
It is, then, believed that such reports may be relied
upon as approximately correct, making some c;dculation
for the irregular burials resorted to b}'' the colored people and
some whites who are driven to seek a spot of ground beyond
the control of city authorities, in order to escape the cruel
tax which the extravagant fashion of burial now imposes
upon white and black, rich and poor. This has gradually
been corrected in Wilmington, where a regularly organized
burial place, under a responsible keeper, has been estab-lished,
so diminishing the error.
Another source of error is also to be considered. In all
towns there is a rivalry about the increase of population,
and as we get farther away from the last census, the tempta-tion
to estimate the population has been great in all the
towns. Wimington, by the census of 1880, had 17,360, but
iiow a new estimate has been placed upon it. Following a
practice in some other States, the population is estimated
-upon the record of registered voters. As ascertaining the
number of voters this is multiplied by five, which is believed
to be approximately correct. The fallacies of this must be
apparent. For instance, the census preceding an election in
NOETH CAKOLINA BOAKD OF HEALTH. 6
wh'ch there was great excitement by reason of vital issues,
and thorough canvasses by good speakers, would be much
larger than where there is general apathy. The tendency is
to over-estimate population, and it may be safely considered
that the mortality reported is under rather than over the
mark.
The desire of the Board is to agree upon some estimate of
population, and to impress upon authorities to see that no
burials are permitted except upon the certificate of some
physician or duly authorized person.
One other source of inaccuracy may be noted in the diag-nosis
of causes of death. All physicians are not equally
careful in making diagnoses, or even equally competent.
Sometimes they state merely the last cause of death. For
instance, naming " convulsions" as the cause of death, when
the real disease might be " hemorrhage," or " asthma," the
"hemorrhage" signifying really aneurism of the aorta, the
sac bursting into the trachea. The most common cause is
probably the post mortem diagnoses, which are made by
Superintendents of Health. In few cases have they the
time, or are they encouraged b}'^ the prospect of a fee to make
a thorough post mortem dissection, to ascertain the cause,
perhaps, in no other cases than such as are ordered by the
coroner. The Superintendent, therefore, has to rely many
times upon the narration of symptoms gathered from igno-rant
friends.
The rectification of the above errors we must strive for,
the ascertainment of truth being the desirable thing, and
not the purpose of making one town more healthful than
another, numerically.
The number of counties reporting has increased from forty-two
in our April, 1887, Bulletin, to fifty-eight in our January,
1888, Bulletin, and the number is slowly increasing. The
character of the reports need not be commented on here,
but the desire on the part of most Superintendents is to do
better, their success depending very largely upon the
6 SECOND BIENNIAL REPORT
unanimity and intelligence of physicians in the different
counties.
Epidemics.—During the past year no considerable serious
epidemics have happened. In Wilmington, scarlet fever,
which had lingered as a sporadic disease for a few years,
finally gathered force enough to be considered epidemic
;
although there were hundreds of cases, there were not to
exceed a dozen deaths from this cause.
Measles were unusually widespread in the eastern counties,
especially Columbus and New Hanover, but even the remote
causes of death made the mortality below the average in this
disease.
Cerebro-Spinal Meningitis.—After an exemption of nearly
twenty years, quite a sharp outburst of this disease occurred
in Buncombe, principally in Asheville, claiming the usual
number of victims. It occurred also in scattered cases in
other counties of the west, but not in an epidemic form. We
are hoping to get a thorough investigation of the causes of
the outbreak, as this disease may be fairly considered a pre-ventable
one.
Small-Pox.—The whole countr}^ was on the lookout for
this disease this year, and the Conference of State Boards of
Health agreed upon a notification of the occurrence of cases
to each board represented in the Conference. The State of
California made the first report, then Louisiana, then Kan-sas,
then Tennessee, then Maine, then Pennsylvania, then
North Carolina, and so on in pretty quick succession, the
port of New York being the source of imporiation in most
of the cases.
In March, Dr. James Spicer reported by telegram that a
case of small-pox had broken out, asking for vaccine to be
sent. This was done immediately. We were then informed
that the patient was a foreigner, who had come to work
recenth' in a furniture factory in Goldsboro, and who had
come in contact with fellow workmen and boarders. The
NORTH CAROLINA BOARD OF HEALTH. T
case was removed from town, and vaccination was resorted
to. The promptness of action was rewarded by the restric-tion
of the disease to tliis one case. April 11th being the
14th da}^ from the outbreak, and the possible contact of
persons with the sick man, and for the next few days there
being no occurrence of another, all anxiety passed away.
Here is a note from Dr. M. E. Robinson, giving ah account
of the case
:
GOLDSBORO, N. C, April 12th, 1888.
TJiomas F. Wood, M. D. :
Dear Doctor :—One Thomas Read, of Scotch descent, shipped from
Glasgow on the 23d February last, on steamer Circassia, which he says
had a case of small-pox on board which died. They arrived at New
York and were quarantined for only nine hours and were all vaccinated
and let loose on the country. I was called to see him on March 26th.
On the 27th he broke out with an eruption which looked very suspicious.
I called in Dr. Cobb. On the 28th called in Dr. Kirby. At first we
thought it was measles, that is, on the 27th ; on 28th pronounced it
small-pox, and at once quarantined it. He is now about well—able to
keep up and about the house.
We have been fortunate not to have another case.
Very Respectfully,
M. E. ROBINSON.
Suspected Small-Pox.—June 6th, 1888, a telegram was
received from Dr. N. Anderson, the Superintendent of
Health of Wilson, notifying the Secretary of a case of
disease suspected to be varioloid.
Wilson, N. C, June 6th, 1888.
Dr. T. F. Wood, Wilmington, N. C. :
My Dear Sir :—There is a case of eruptive fever in town and there is
very grave suspicion that it is one of varioloid ; in fact, one of the physi-cians
called in to see the case is not at all doubtful, but upon very care-ful
enquiry as to history, etc., there is much doubt thrown around the
whole matter. As an act of prudence, however, I have directed that
the case be removed to the country and isolated. To satisfy the citizens
8 SECOND BIENNIAL REPORT
of our town, as tliere is an amount appropriated by the State for such
purposes, I would respectfully request that you send an expert to-morrow
to see the case.
Very truly yours,
N. ANDERSON.
Vaccine matter was promptly forwarded and the patient
isolated. Doubts and apprehension i-till hung around the
case and a member of the State Board was sent to investi-gate
it.
The patient, a citizen of Wilson, had been discovered to
have an eruption, which was pustular and covered the whole
body. For some weeks he had not been away from Wilson,
and then had been residing or visiting localities where there
was no small-pox. There could hardly be a more difficult
matter than to determine the exact nature of this disease.
The pustules were distinct, round, pustular, in some places
umbilicated. Inspection and inquiry revealed these facts:
The patient had no initial fever, backache, frontal headache
;
the eruption did not begin on the forehead and pursue a
regular course on the neck, arms, chest, etc., but was as much,
in the beginning, on the legs and body as elsewhere ; crust-ing,
which was just begun, was not in the usual order on
the face, but scattered about; the patient had been vaccina-ted
within a few years, but the eruption dimmed the cicatrix,
if there was any of a well marked character; the odor of
the body was not characteristic ; the sore throat was not that
of small-pox. Altogether, there was hardly ever to be
imagined a case so nearly like small pox not to be one, and
a person with a like eruption during the prevalence of
small-pox, would almost without c|uestion, be hustled off to
a lazaretto. The deciding point la}'' in the fact that the
patient had a hard-chancre still uncured, settling the diag-nosis
as one of pustular syphilide.
The announcement of this conclusion by the consulting
physicians allayed the alarm of the community, rendering
thereby, the sort of assistance so much needed, and which
NORTH CAEOLIXA BOARD OF HEALTH. 9
the State Board has been careful to apply. The manage-ment
of panics, the arrest of idle rumors, and the restoration
of confidence is hardly secondary to the prompt isolation of
disease.
The epidemic fund of the Board held in reserve for the
emergency of an epidemic outbreak has never been drawn
upon, but is sufficient for all purposes; it is under the con-trol
of the Governor. The State Board, though, does not
hesitate to send means of prevention with all dispatch to
localities where it is needed. Vaccine we keep constantly
within reach in a fresh state, but the Board does not attempt
to furnish it gratis, as no provision is made for it. There is
a provision for it in the general law, making the expense in
emergenc}' devolve upon the officials of counties.
Yellow fever in the South—Its Effects upon trade
AND TRAVEL ThE DaNGERS OF PaNIC.
During the winter of 1887, there were rumors of a disease
which made its appearance in the Peninsula of Florida,
being infectious. During the early Spring of 1888, cases
occurred in Jacksonville, which, before midsummer, were
known to be yellow fever. The reports were very conflict-ing
as to the nature of the disease, and Florida having no
Board of Health to give authentic information, rumors of
the wildest sort spread all over the country. The alarm
which succeeded these reports could hardly have been greater
at theimmediate points of danger than at points very remote,
especially in such towns and cities as had once been the
victims of the disease. The most shameful panic overcame
some communities, and the disgraceful sliot-gun policy, with
which the public is so well informed, was inaugurated as the
proper thing to avert disaster. Men, women and children,
fleeing from the enem}^ were detained or refused admittance
to towns; railroad travel was interrupted, and trade of all
sorts hampered or ruined.
10 SECOND BIENNIAL REPORT
In our State, the greatest danger was apprehended as to
the sea-coast towns, as they had had 3'ellow fever once in
their history, and were in more direct railroad communica-tion
with Florida.
Wilmington established inland quarantine in July and
kept it up until November. Little could have been done
but for the hearty cooperation of the officials of the Atlantic
Coast Lines. Dr. F. W. Potter, acting by the advice and
with the hearty support of the County Board Health, had
placed at his command means adequate for the emergency.
The Mayor of Wilmington, Hon. John J. Fowler, gave hearty
acquiescence, and rendered excellent service in his official
capacity, and as a private citizen. Two policemen, selected
for their judgment and intelligence, were stationed at the
Navassa Guano Factory, four miles from Wilmington, on
the west side of the Cape Fear River. Fearing that this
would not be sufficient, additional officers were sent, one to
Florence, S. C, and one to Maxton, N. C, to detect the
attempt of any coming by circuitous route from Florida,
warning any such that they would not be admitted into
Wilmington without being detained at an improvised quar-antine
station. The officials of the Atlantic Coast Line were
as anxious to keep out persons from the suspected districts
as the Board of Health officials, and they acted with pru-dence
and forethought, inflicting as little inconvenience as
possible on the through northern travel. A dining car was
placed at a convenient distance from the town, and the cars
properly fumigated by sulphurous acid fumes. These pre-cautions
excited considerable alarm among the igi orantand
timid, and some suspects, a family or two from the infected
district, having been detained for observation until they
could be sent in the country, were suspected of having the
fever, and the suspicion grew into a rumor, and a rumor
into a positive statement that there was actually a case of
yellow fever in Wilmington. Panic now became widespread,
and the old popular delusion of burning tar-barrels was
NORTH CAROLINA BOARD OF HEALTH. 11
resorted to, as a means of purifying the air and warding off
danger. In the meantime, telegrams of enquiry were rush-ing
in from distant towns, and the whole population for
miles around was in a state of ferment.
During this excitement a vessel came in to the Cape Fear
River from New York laden with railioad iron. As soon as
it was known that the quarantine officer at Southport had
informed the Wilmington membersof the Quarantine Board,
according to his usual custom, that this vessel several weeks
before had been in Jacksonville, more fuel was added to the
flame. The Wilmington members of the Quarantine Board,
in the regular discharge of their duty, visited the quarantine
station to inspect this vessel, and while on board received
telegrams from Wilmington, protesting against this vessel
coming up to Wilmington on any terms, and even suggest-ing
the impropriet}' of the members of the Board visiting
the vessel. A close inspection revealed the fact that the
vessel was in Jacksonville some days before the first case of
yellow fever had been reported in that city ; that she loaded
a mile from the town; that her crew had not been ashore,
and being mostly Scandinavians, a people more susceptible
than usual to yellow fever; that several weeks had elapsed
since her departure from Jacksonville. She had gone to
New York and received a cargo of iron rails. The storage
of such cargo is of such a nature that it can be easily exam-ined,
and also the entire hold of the vessel. Everything was
found in good sanitary condition, there was no sickness on
board, and the unanimous i pinion of the Quarantine Board
was that the vessel should be accorded free pratique into our
port. In deference, however, to the respectable citizens who
had entered their protest to her admission, we asked for an
interview with such representatives of the people, with the
County Board of Health, as were willing to meet us. Accord-ingly,
the meeting was held, the state of the case as regards
the vessel clearly set forth, and a free expression of opinion
asked for and given. After this the two members of the Quar-
12 SECOND BIENNIAL REPORT
antine Board expressed their belief as to the justice of this
vessel being allowed to come to her wharf in the city, in
peference to a resolution, pratique was refused for the
present.
The formal resolution was then introduced .-etting forth the
reasons why the representatives of the several interests of the
city were opposed to the admission of the vessel, endorsing
at the same time the action of the Quarantine Board, and
making themselves responsible for her detention.
In efiect, this was an organized, but very respectable
opposition of the Quarantine laws. It was all the more
embarrassing because some members of the county Board of
Health were also members of the Quarantine Board, and the
law sets forth that maritime qu;irantine "shall not be inter-fered
with, but officers of the local and State boards shall
render all aid in their power to quarantine officers in the
discharge of their duties, upon request of the latter."
Furthermore, it was admitted by the members of the
Quarantine Board present, that the means of disinfecting
vessels at Southport were of the most primitive character
and not at all adequate to the complete sanitary preparation
of vessels. It was very evident in summing up the whole
discussion for and against, that as citizens and health officers
we were not only performing the functions of sanitary
experts, but were called upon also to manage a panic which
was threatening to disorganize the trade of Wilmington. It
seemed prudent, therefore, to allow the objectionable vessel
to remain at her anchorage at the station, until the com-munity
had reached a calmer and more reasoning state of
mind. The hardship to the vessel was great, and in reality
her expenses should not have, and would not have fallen so
heavily, had there been at the station efficient means of
sanitation. This description of the difficulties of a panic
serve to demonstrate the necessity of State action to save our
commerce from unjust losses by the erection of a proper
NORTH CAROLINA BOARD OF HEALTH. 13
, quarantine, of which there will be mention under the head
of quarantinein another part of this report.
A Reported ('ase of Yellow Fever.
When the panic was at its height, there appeared in the
public daily press a dispatch from a member and officer of
the County Board of Health of Pender, stating that a case
of yellow fever had occurred in that county.
Dr. W. T. Ennett, the Superintendent of Health of Pender
count}^, was telegraphed to, and in addition to his telegram
in reply saying that he had received no information, sent
also the following
:
BURGAW, N. C, September 19th, 1888.
Dr. Thos. F. Wood :
Dear Sir :—I received your telegram this morning and answered at
once. We had heard nothing of the case till we read your telegram. I
wrote at once to Dr. Murphy asking him the particulars, when I hear
from him I will notify you at once, or, if he does not reply, had I not
better go and examine the case.
Respectfully and truly,
W. T. ENNETT.
Later the following in substance was received from the
Superintendent of Health, Dr. Ennett:
He found the man Anderson [suspected to have the yellow fever] lives
twelve miles from Burgaw, beyond the Northeast River, and he was
then up and out of doors and eating regularly and seeing his neighbors
that day, they were as much surprised as I at the report. From what I
could gather, I decided it was " Hemorrhagic Malarial Fever."
This added more fuel to the flame, and telegrams came
pouring in, making enquiry as to the genuineness of the
case. The Secretary of the Board secured the valuable ser-vices
of Dr. William J. Love, of Wilmington, an expert in
yellow fever, he having served during the epidemic in. Wil-
14 SECOND r.IENNIAL KEPOK'I'
mington in 1862, and having suffered from the disease in
his own person, to visit the spot and determine the truth or
falsity of the report.
The following is his report:
Wilmington, N. C, September 20th, 1888.
Dr. T. F. Wood, Secretary North Carolina Board of Health
:
Sir :—I have the honor to report, that in obedience to your instructions,
I visited Burgaw in order to investigate a case supposed to be yellow-fever.
The patient lives ten miles east of the tow^n, across the North-east
Cape Fear River. He was taken with a chill at 8 p. m. on the 7th
instant. During the night he was affected with nausea and vomited
blood. The vomiting continued at intervals until the afternoon of the
9th assuming the character of black vomit. The alvine dejecta indica-ted
hemorrhage. There was no epistaxis nor hematuria. Upon the
subsidence of the vomiting, icterus presented itself. The temperature
at no time went beyond 102 degrees F. There was some frontal head-ache
and pain over hepatic region and in the abdomen, but no uneasi-ness
about the loins and lower extremities. These points were kindly
given me by the jihysician in charge. I saw the case this morning.
The icteric hue of the skin had nearly subsided and the adnata presented
no discoloration whatever. There was no fever and the man was able
to be up and dressed. He is twenty-seven years of age, healthy and
temperate. His last attack of sickness, pneumonia, occurred six years
ago. His diet was the usual one on the 7th inst.
My diagnosis was paludal fever accompanied by gastric and intestinal
hemorrhage, these being points, in a yellow fever panic, sufficient to
excite the alarm and suspicions of the community. I was particularly
impressed with the apparent insalubrity of the residence, situated in a
neck between the river and a creek with cleared swamps to the east,
soutii and west, embracing three-fourths of a circle, but the patient
stated that he had very little sickness in his family, a remark corrobora-ted
by the medical man in attendance.
The patient had not been exposed to yellow fever infection, his only
trip away from home having been a visit to Wilmington three weeks
ago, his stay consuming but a day or two.
Very respectfully yours,
Wm. J. LOVE.
Doubtless the reliance placed in this report served to allay
excitement.
It is appropriate, at this point, to call attention to the
NORTH CAROLINA BOARD OF HEALTH, 15
necessity of physicians and others holding quasi positions as
custodians of the public health. The eyes of the commu-nity
are upon them, and an}' indiscreet or premature state-ment
may result in widespread harm, as in the case above
referred to. Letters of enquiry from railroad officials and
boards of health of distant States, showed how fast the bad
news had travelled, and how eager every one was to know
what the State Board was doing about it. There seems to
be no remedy for such indiscretion, except the reaction
which rebounds upon the unfortunate or guilty perpetrator
of premature or ill-judged opinions.
There is a proper way to proceed in reporting suspected
cases, and it is clearly set forth by the law. It is the duty
of every member of the County Boards of Health to report
promptly to the Superintendent of Health of his count}',
any case of suspected pestilential disease. It is the duty of
the Superintendent to examine into such cases and report
them promptly to the Secretary of the State Board of Health,
in order that proper action may be taken to prevent its
spread, and to control panic in the business world.
In this connection the State Board makes the suggestion
that there should be
Compulsory Notificaiion of Contagious and Infectious
Diseases dangerous to the Public Health.
Prompt action is the only course of safety in dealing with
pestilential diseases. The early detection of a case, and
prompt isolation promises success. All physicians do not
see the necessity for such action, or do not recognize the
policy of prompt notification : some even act upon the prin-ciple
that their cases are matters of jirivate concern, with
which public health officers have nothing to do, so that to
obtain the best results, there should be a uniform rule of
action.
16 SECOND 15IKNNIAL REPORT
The Colonization of Yellow Fever Refugees in
Hendersonville.
The following correspondence was received at this office
in reference to the colonization of refugees from Jackson-ville
in the mountain regions of the State
:
[Telegram.] "Jacksonville, Fla., Sept. 4, 1888.
Thos. F. Wood, Secretary State Board of Health :
We have wired Gov. Scales, at the suggestion of Surgeon General
Hamilton, M. H. S., for permission to send our jieople, not exceeding
five hundred, who have means to go, to places in the mountains open
to them. What restrictions will State Board of Health impose ? Can
you suggest names of places you would recommend, and the number
thev can accommodate ?
NEAL MITCHELL, M. D.,
President Board of Health,
D. T. GERAW,
Acting Mayor,
P. McQUAID,
Acting President Auxiliary Association."
The following from Gov. Scales
:
[Telegram.] "Greensboro, N. C, Sept. 9th, 1888.
Dr. Wood, Secretary State Board Health, Wilmington, N. C. :
Surgeon General Hamilton, M. H. S., advises authorities of Jackson-ville
to ask me if their citizens, not exceeding 500 in number, will be
permitted to go to the mountains of our State to such places as are will-ing
to receive them? What answer shall I make? Answer here, at
once. A. M. SCALES,
Governor."
Knowing that there were some towns willing to admit
refui^ees from Jacksonville, I telegraphed Dr. W. D. Hilliard,
of Asheville, member of the North Carolina Board of Health,
to communicate with the towns in the mountain sections,
ascertain what places would be willing to receive them, in
what numbers, and under what restrictions:
NOl^TH ( AP.OLINA HOARD OK HEAl/rH. 17
[Telegram.] Asheville, N. C, September 7th, 1888.
Thos. F. Wood :
Hendersonville will receive five hundred. Hickory gives no number.
W. D. HILLIARD.
[Telegram. 1 Murphy, N. C, September 6th, 1888.
TJws. F. Wood :
We can furnish local accommodations for one hundred, and as many
more as liave tents.
Dr. ABERNATHY,
Superintendent of Health of Cherokee Co.
Pending answers from Superintendents of Plealth of the
mountain counties willing to move in the matter, and
awaiting their decision, the following was received:
[Telegram.] Washington, D. C, September 7th, 1888.
Dr. Thos. F. Wood, Secretary State Board of Health, Wilmington
:
What conclusion have you reached in regard to allowing cars of refu-gees
to go to the mountains of North Carolina.
HAMILTON, Surgeon General.
In the meantime, the following came:
[Telegram.] Asheville, September 8th, 1888.
Dr. Thos. F. Wood:
Waynesville extends cordial invitation.
W. D. HILLIARD.
The following letter from Dr. L. L. Johnson, Superinten-dent
of Health of Henderson county, in reply to telegram
was received
:
Dr. Wood, Wilmington, N. C, Secretary State Board of Health:
Dear Doctor :—Yours of September 7th received. In reply I will
say, that a telegram was received at Hendersonville from the President
of the Board of Health, of Jacksonville, Florida, asking that they might
send as many as six hundred of their people to this county. After con-sultation
with the physicians and town council, we decided to throw
our doors open to them. I require the clothing to be fumigated. Our
2
18 SECOND BIENNIAL REPORT
town is 3,252 .feet above sea-level, and we cannot think that there is the
least danger of any contagion. I will write you in regard to the matter
if anything should occur.
Very respectfully,
L. L. JOHNSON, M. D.,
Superintendent of Health of Henderson Co., N. C.
In reply lo a telegram to the Mayor of Hendersonville
(the County Superintendent of ITpalth, Dr. Johnson living
in the country and not accessible by telegraph), asking what
restrictions the County Board of Henderson had placed upon
the refugees, the following was received :
[Telegram.] Hendersonville, September 8th, 1888.
Thos. F. Wood, State Board of Health
:
Letter not received ; have made no restrictions ; should we make any ?
if so, what, and how ?
J. P. RICKMAN.
In reply to this, instruction was sent that the refugees, on
arrival, should be paroled not to leave Hendersonville under
ten days; that they should be kept under surveillance in
order to prevent their entrance into towns where their
presence would be objectionable.
The following from Asheville, in response to telegram,
asking if that city w^ould quarantine against Florida refu-gees
:
Asheville, N. C, September 6th, 1888.
T. F. Wood :
Am instructed by Mr. Harkins, Mayor of Asheville, to say there has
not been, nor is there, any quarantine against any one. Hickory and
Hendersonville extend cordial invitations. Other points not yet heard
from. W. D. HILLIARD.
After ascertaining what towns would be willing to receive
the refugees, telegrams were sent the authorities in Jackson-ville,
and the following is the reply
:
NORTH CAROLINA BOARD OF HEALTH. 19
Jacksonville, Florida, September 7th, 1888.
Thanks for information furnished. Will wire places you name for
number they can accommodate. As we understand it, the State Board
of Health of your State will not impose any obstacles on our people going
to such places in your State as offei*ed to receive them. Is this correct?
Answer.
P. McQLTADE, Acting President.
Such restrictions as were enjoined upon the Henderson-ville
Board of Health were communicated to Mr. McQnade.
The following is a letter of instruction to Dr. J. F. Aber-nathy.
Superintendent of Health of Cherokee county, with
his reply. (This letter was in substance what was written
to each town offering to take refugees into their hospitable
borders.)
NORTH CAROLINA BOARD OF HEALTH,
Secretary's Office,
Wilmington, September 7th, 1888.
Dr. J. F. Abernathy, Supt. of Health, Cherokee Co.:
Dear Doctor :—I understand that Murjjhy is willing to receive one
hundred people from Jacksonville, Fla., refugees from the yellow fever.
Please state fully how they will be cared for, and what restrictions will
be imposed upon them. You are aware that by the terms of the law,
you must state the restrictions to be imposed upon them, and that you
act by advice of the County Board of Health. Please summon the Board
of Health, and determine upon rules and send me particulars. I would
insist that all who take refuge in your country shall be paroled not to
go to towns that have not extended a welcome, and use what watch you
can to prevent it. Telegraph at expense of State Board of Health, when
necessary. Yours, very truly,
THOMAS F. WOOD.
What altitude is Murphy above sea ?
Murphy, N. C. Sept. 10th, 1888.
Dr. Thos. F. Wood :
Dear Sir :—Your letter before me seems to be one of inquiry—to know
what manner of comforts we can give the Jacksonville refugees, and
what precautionary measures had or would be made for the people's
protection ?
1st. We can give them good second-class hotel fare, good, comforta-
20 SECONh lUKNXIAI. liKl'OItT
ble beds, good diet, and all the fresh air and pure water they or any one
else could dosire. Any more than one hundred refugees would have
trouble to find a lodging place, owing to the immense influx from other
States, and there is no good reason to think that our hotels and board-ing
houses will be vacated of their transient boarders before late autumn.
Nevertheless, if more were to come than we could accommodate as we
wish to, we would not in any way cast them off.
2d. I have consulted" from time to time with the Board of Health,
and what I have done has been sanctioned by the Board. I have the
best authority to believe that we run no considerable risk. The Board
of Health will meet them at the train and exchange all the passengers.
and any one who, in the opinion of the Board, is suspicious or unsafe.
will be isolated immediately.
The altitude of Murphy is 1,684 feet, although we can ascend to a
greater height in half a mile of Murphy. Thermometer shows 66" in
open air. Nights very cool; days pleasant.
J. F. ABERNATHY,
Co. Supt. of Health.
Some entirely new questions arose during the past sum-mer,
as partially related in above correspondence, as to the
proper disposition to make of persons taking refuge in our
State from Jacksonville, Florida. The depopulation of the
last named city being decided upon, the next anxious ques-tion
was, what towns will receive them ? Extensive corres-pondence
and telegraphing finally revealed the fact, that the
towns of Murphy, Hendersonville, and several others were
willing to allow these refugees to take up their abode in their
midst.
The question naturally arose, who had authority to per-mit
this colonization of persons from a pestilence stricken
district. The only section of our law bearing upon this
point was that found in Section 9 of the lavv relating to
the public health, which is as follows:
Sec. 9. Inland quarantine shall be under the control of the County
Superintendent of Health, who, acting by the advice of the local board,
shall see tliat diseases danger^'us to the public health, viz : small-pox,
scarlet fever, yellow fever and cholera, shall be properly quarantined or
isolated at the expense of the city, or town, or county in which they
occvir. Any person violating the rules promulgated on this subject
NORTH CAROLINA BOAIIT) OF HEALTH. 21
shall be deemed guilty of a misdemeanor, and upon conviction thereof
shall be fined or imprisoned at the discretion of the court. In case the
offender be stricken with disease for which he is quarantinable, he will
be subject to the penalty on recovery, unless in the opinion of the super-intendent
it should be omitted. Quarantine of ports shall not be inter-fered
with, but the officers of the local and State Boards shall render all
the aid in their power to quarantine officers in the discharge of their
duties, upon the request of the latter.
It was ascertained that Dr. L. L. Johnson, the Superinten-dent
of Health of Henderson count}', after consultation with
the Henderson Board of Health, signified his willingness to
allow the refugees to make their homes in the town of Hen-derson
ville. Accordingly, on the -- day of September a train
containing 260 persons were landed in the town, under the
care of Surgeon Guiteras, of the Marine Hospital Service,
and they were at once distributed and cared for. It is very
remarkable to record that no cases occurred after they
arrived in Hendersonville, and although ten were sick, only
two died ; thus justifying the confidence the County Board
of Health had in the salubriousness of their climate and the
entire safety of the citizens in assuming such an apparent
risk.
Hendersonville is a town of 1,500 inhabitants, situate in a
mountainous region, 2,252 feet above the sea level. The
drainage of the town is considered good, but there is no
sewerage or public water supply. Every year the visitors,
who are seeking health and recreation, amount to as many
as 600 at one time, and for four months of 1888, from 2,000
to 3,000. The town has an extensive reputation for salu-brity,
and on this account is growing in importance 3'ear by
year.
The courage and good faith of the people in rendering
service to the afHicted was manifested in the fact that eight
families took numbers of them into their own homes, vary-ing
in numbers from three upwards. The largest number
collected in one house was fifty, the smallest three. Doubt-
22 SECOND I5IENNIAL lilOPOllT
less the kindness of the citizens of Ilendersonville will long
be cherished, and probably the Board of Health would be
willing to extend an invitation under like conditions in the
future. This, like all questions concerning the public health,
involves the greatest good to all, and must be considered
solely by this standard. It is well enough for a town, ele-vated
2,252 feet, to think themselves secure, but while en-joying
this security, the danger to their neighbors must be
duly considered.
In this case, consultation by telegraph was kept up for
several da^^s, and the lack of proper preparation, after the
refugees were received, caused considerable uneasiness in
Charleston and Wilmington, so that these cities quarantined
against Henderson ville. This precaution was none too soon,
as two of the refugees came to Wilmington seeking admis-sion
and were properly turned away. The practical experi-ment
opened up the true gravity of admitting these refugees
to any part of the State, and the Board of Health decided to
discountenance any further admission of them into the State,
without they were properly cared for in a hospital camp,
under sufficient guard, and in this opinion Gov. Scales
promptly acquiesced, and the authorities in Florida and
towns desiring to offer hospitality were duly notified.
In view of this experience, the question may be properly
asked, what additional safeguards should be inaugurated to
prevent a similar risk in the future? The State Board
makes this suggestion : That no colonization should be per-mitted
of persons from a pestilence stricken district, except
upon express permission of the State Board of Health and
the approval of the Governor, and only then when the money
for maintaining such a camp is guaranteed by responsible
parties immediately interested ; and further, that strict rules
and regulations should be specified and established by the
State Board, controlling the movement of all persons con-nected
with such camp. Our humanity may prompt us to
NORTH f'AIIoLrXA EOAKD OF HEALTH. 23
offer succor to distress, but it should uot betray us into any
action which will endanger other communities.
From the course of the epidemic in Florida during the
spring, summer and fall of 1888, there are grave apprehen-sions
that we wnll have a repetition of the same serious state
of things the next year, and prompt means should be taken
to enable the Board of Health to put into execution a rea-sonable
quarantine for 1889.
Maritime Quarantine.
The dangers of the importation of pestilential diseases
through our seaport towns is increasing 3'early with the
increase of railroads piercing the interior of our State. Espe-cially
is this true as regards Wilmington. The quarantine
law governing the latter port is as good as could be desired,
but the means at the disposal of the Quarantine Board are
limited.
It will be remembered, that Southport at the mouth of the
Cape Fear River, the entrepot of Wilmington, is located in
a land-locked bay, 25 miles from that cit}'. The roads on
either side of the river are so bad that it practically Wars the
escape of persons detained at quarantine, and the river is
easily guarded. The roadstead at the quarantine station is
good, and large vessels can load and unload at this point.
There could hardly be a better location for a hos])ital or for
the establishment of a disinfecting station. The defects are,
there is no hospital, and there is no wharf at which vessels
could be moored to prevent upsetting when emptied of the
cargoes for disinfection. An appropriation for this purpose is
a commercial necessity, to prevent the prolonged detention
of vessels. For many years the quarantine service of this
port has been so well managed, that no cases of pestilential
disease have been admitted into Wilmington, but the State
should see that her chief port is not hampered by a manage-ment,
which, for lack of modern outfit for properly disinfect-
24 SECOND BIENNIAL REPORT
ing vessels and isolating persons, is sometimes a hardship to
vessel owners. The Board of Health of Wilmington have
alwavs acted in harmonv with the Quarantine Board, and
they see the necessity of some action by the next General
Assembly in appropriating money for a new and improved
outfit.
The following correspondence from Dr. W. G. Curtis, who
for years has acted so acceptably as quarantine officer at
Southport, we give in this connection :
QUARANTINE STATION,
Southport, November 16th, 1888.
Dr. Thos. F. Wood, Secretary State Board of Health :
Dear Sir :—By section 2876, chapter 24, of The Code of North Caro-lina,
it is provided, among other things, that tlie State Board of Health
" shall direct the attention of the State to such sanitary matters as in
their judgment affect the industry, prosperity, health and lives of the
citizens of the State.'"
North Carolina possesses a salubrious climate, and her natural advan-tages
for healthfulness are unexcelled by any State in the Union. But
there is always a possibility of danger from without, and during the
past season, there has been a probability of danger so imminent as
seriously to alarm our citizens. Commerce brings us in intimate rela-tions
witli all the world, and with many places where pestilence walketh
by noonday and seeks and spares not the most healthful localities. The
avenues of approach are many, and with increasing commerce, and
increasing prosperity, dangers accumulate and the avenues have to be
more strictly guarded.
The principal avenue by w]iich dangerous diseases may approach our
citizens is tlie Cape Fear River. It may be said, I think, without fear
of contradiction, that if the quarantine service at the mouth of this
great river were relaxed or discontinued, there would follow constant
invasions of pestilential diseases, and prosperity would cease. The pro-ductions
of North Carolina would seek other outlets. Our citizens
would not expose themselves to dangers arising from pestilence. They
would have no confidence in our merchants, and would rightly think
that such carelessness must extend to all business transactions. The
importance of the port of Wilmington would d%vindle into insignificance,
and the quotations of her markets would cease to be reported.
The quarantine service, therefore, ought to be perfected in every way
known to science. It ought to be a jjopular service, looked up to by our
people with confidence, and supported bj' liberal appropriations, when
NORTH CAROLINA BOARD OF HEALTH. 25
necessary. Tlie present cost of this service is in the vicinity of one mill
per head of the population—an amount so small that no one of that
population has ever yet found out that he has paid it. The cost of one
outbreak of yellow fever in Wilmington would be estimated as cheap
at twenty million of dollars to the citizens of North Carolina. The cost
of an idle rumor on the streets of that city, cannot, of course be esti-mated
in money ; but it is considerable and certainly amounts to a day
or two of great discomfort for several tliousand people.
It seems, then, that it would be wise policy to spend a little money
for the perfection of this valuable service. But little is needed or asked
for. At the last session of the General Assembly a bill was introduced
appropriating seven thousand dollars for rebuilding the hospital and
the construction of a wharf. The bill was so drawn as to provide fully
and permanently for the service^, and only in the event of Wilmington
becoming a city of fifty thousand or more of population, was it expected
that any fuither appropriation would be asked for. The design was,
that for and in consideration of an appropriation of seven thousand dol-lars,
and a yearly tax of about one mill per head of the population.
North Carolina should have a permanent and self-supporting quarantine
establishment, for the protection of her citizens from all such diseases
as are brought to us in ship ; that is to say, from cholera, shij} fever,
yellow fever, and incidentally from small pox, though it is to be sup-posed
that an enlightened people will protect themselves from the latter
disease by vaccination. This seems a sufficiently small sum with which
to purchase such benefits. I suppose there might be found within the
limits of North Carolina many hundreds of people who would cheer-fully
pay that amount out of their private purses, rather than have
either of those malignant diseases invade their families. There are
many thousands who would gladly pay that amount and more, if they
had it, to secure immunity,—so dreadful are these diseases, and so
fatal, seeking out, it almost seems, the best, the bravest and the most
honored among the people.
Arid what do the poor think about these things? and the vast major-ity
who cannot fly from pestilence, but must stand and face it? What
should they think, but that they have wise and humane legislators, who
will interpose all the protection and relief that may be put in the pro-visions
of law for such benificent purposes made and provided ?
The quarantine laws of North Carolina are ample, and no particular
revision is suggested. But section 2915 of chaj^ter 24 of The Code pro-vides,
that a hospital shall be established. It aeems, therefore, obliga-tory
upon the General Assembly to provide the means for building such
a hospital; but waiving that question of law for the present, I will
endeavor to show the necessity of such an establishment, if we wish to
preserve a reputation for humanity, and build up prosperous cities.
26 SECOND BIKXXIAL KEPORT
An example, which iiiay occur at any day in the year, seems best
adapted as an arjj;ument to show what ought to be dcme.
An infected ship comes to the Quarantine anchorage. There is yellow
fever on board, and the sick and well are confined together within the
small compass of the ship's quarters. The sick, if not past thinking,
expect to die. There is terror among those not yet stricken down. The
news travels fast, and dread settles like a pall over the vicinity. What
is to be done for their relief—and how shall the germs of infection be
destroyed? Shall those as yet not infected be compelled to remain on
board to sicken and die in their turn V Must the germs of disease lie
festering and accumulating in forecastle and cabins, a constantly increas-ing
focus of danger to the community ? Shall this ship be forced to lie
at her anchorage for month after month, rotting and wasting, and being
consumed by expenses which will never cease until she is a total loss to
her owners?
Is it necessary that this great channel of commercial activity—this
natural outlet for the cotton, the naval stores, the timber—the future
coaling station of the South Atlantic, and nearest point of shipment
for the great West—should have to acquire so evil a reputation through-out
tlie world that ships would not come here on the same terms offered
by neighboring cities of the Southern coast?
To all these questions, it must be answered that, at present, there is
no remedy. Given the infected ship, and the evils described, will hap-pen,
and perhaps worse, for it will be difticvdt, if not impossible, in a
period of prolonged detention, to keep the disease from invading the
neighboring shores.
What, then, is to be done? The answer is simple, and I call upon the
State Board of Health to assist the Quarantine Board in bringing this
matter before the next session of the General Assembly, to the end that
a hospital may be built, and th-Tieby the evils described be averted.
Then, when the infected ship ai-rives, we will take out the sick and
cure them, if we can, in a comfortable hosijital—if they are unfortu-nately
beyond our skill, and die, we will bury them in thehosi^ital cem-etery
like Christians, instead of digging a hole in the nearest beach,
from which they will be washed out by the first storm to the terror of
passers by. We will take out the well also, and place them under obser-vation
in another and isolated building. We will then proceed without
delay to remove ballast and everything capable of carrying infection,
and disinfect the ship.
After this is done, and the period of incubation has passed, we will
take all the surviving crew and put them on board again and set them
on their way rejoicing, as they must do after escaping so great perils.
And for all these services, the owners will not only gladly pay the
bills, but thank the State of North Carolina for the beneficent laws that
have insured such humane treatment.
This argument treats mostly upon the propriety of an appropriation
NORTH CAROLINA BOARD OF HEALTH. 27
for the purpose of carrying out existing law, and building a hospital,
from a saijitary point of view; but its commercial and economic aspect is
equally' forcible in procuring the desired legislation. Tlie port of Wil-mington,
which includes all of the Cape Fear River as far as its naviga-ble
vsater extends, is of growing importance, and the attention of the
world is being attracted to its improving bar, and the extensive and
valuable harbor facilities contained within it. Wilmington is connected
with a large i)ortion of North Carolina by means of railroads already built.
Merchants, wielding a vast capital, have established tliemselves, and are
ready, and offer facilities for the transaction of all the business which
comes to tlie wharves and warehouses they have constructed.
Not only the merchants, but their customers throughout North and
Soutli Carolina desire, and are entitled to have, tiie protection of the
most enlightened sanitary laws. Railroad connections with the interior
are constantly enlarging the limits of the trade, whicii aims to take in
the markets of the world. A great trunk line is projected from the
mouth of the Cape Fear at Southport, in a straight line and by the
easiest grades to Bristol, Tenn., and thence with all the great cities of
the West. Tiiis Ime of construction will connect by the shortest and
cheapest route one-half of the State of North Carolina with the mouth
of the Cape Fear River. There will be largely increased commerce with
West India and South American jjorts. There will be more danger, but
wise legislation will provide the facilities for meeting it. What is wanted
is a good sanitary record for the Cape Fear. A vigilant quarantine,
with proper facilities for the treatment of all cases which may arise,
with quick despatch, after its requirements have been obeyed, will give
a good reputation to the port, and insure the confidence of our citizens.
Very respectfully, your obedient servant,
W. G. CURTIS,
Quarantine PJiysician, Port of Wilmington.
Hygienic Teaching in Public Schools.
The school term in most of the counties is so short that
in those counties where the term is longest there is little
tinie avaihible for the systematic stud}' of the elements of
hygienics. If there was time, there are not many books
available for school children and which would be economi-cally
placed in their hands. The Board of Health, in view
of these facts, have endeavored to bring the study of hygienics
to the attention of the teachers, believing that if the Super-intendent
of Public Instruction and the Teachers' Assembly
28 siccoNi) lUENNiAi. hi:p()i;t
conld bo brought into communication with the State Board
of Health, that much that was of common interest could be
inaugurated which would be of advantage to all concerned.
To this end, Drs. Jones and Lewis were sent as representa-tives
to the Teachers' Assembly, and the interview and inter-change
of ideas in reference to the instruction in hj^gieuics
to pupils was a satisfactory beginning.
The Board selected a w^ork of much value for distribution
among the teachers, viz: The Lomb Prize Essays on the
following subjects
:
" Healthy Homes and Foods for the Working Classes" ;
" The Sanitary Conditions and Necessities of School Houses
and School Life"
;
" Disinfection and Individual Prophylaxis Against Infectious
Diseases "
;
" The Preventable Causes of Disease, Injury and Death in
American Mamfactories and Work-shops, and the best means
and Appliances for preventing and Avoiding them."
The above essays are contributions for which a prize of
$1,100 was paid by the philanthropist, Mr. Henry Lomb, of
Rochester, New York, and embrace many of the elements
of hygiene, as applied to the every day affairs of life. It is
by such instruction as they contain that teachers can fit
themselves to instruct children. As before noted, the teacher
can give little or no time to text-book teaching of hygienics,
and must content himself with giving oral lessons, as occa-sion
permits, during the session. Every teacher of expe-rience
can find opportunities to inculcate lessons orally and
practically on the more essential topics which appertain to
healthy lives and healthy homes, an.l if he masters the fun-damentals
himself, and seeks the opportunity to teach them,
he can give a more correct impression to his scholars than
crude text-books interlarded with the " horrid-example "
lessons.
XOKTH CAROLTXA I'.OAKD OK HEALTH. 29
As our efforts, so far, have been well received, the Board
desires to cultivate more intimate relations with the teachers
of the State, and co-operate with them in promoting a knowl-edge
of hygienics.
Of the Organization of County Boards of Health.
In January, 1887, there were tifty-one counties having
organized Boards of Health, which, as compared with the
beginning of 188G, is an increase of eleven having such
organization. The i'unctions of these boards have been of
increasing importance during this period, and at the end of
1888, there are fifty-four. The organization of these county
boards is regarded as of prime importance for the following
reasons
:
Every county has to incur an expense in medical services
to tlie prisoners in jail and house of correction, and to the
inmates of the poor-house ; further, a physician must be
employed for coroner's inquests, and in time of extra emer-gency,
to take charge of cases of pestilential disease. These
are unavoidable expenses, but after all they leave many
items out of account, the more important of which are the
sanitary care of the public institutions. The above services,
too, being probably divided among several plij'sicians, there
is not anything like a continuous sanitary service practica-ble.
The law organizes these duties under the charge of
one responsible officer, the Superintendent of Health, and
makes him responsible for the sanitary inspection of all the
establishments which the County Commissioners have under
their care. The inspection done by the grand jurors, quar-terly,
is only a small opportunity of correcting insanitary
evils that may exist, for, as we have pointed out in our pre-vious
reports, the county functionaries have due warning of
the day of inspection by the grand jury, and the appear-ances
exhibited are not to be taken as criteria of the state of
things for the rest of the j'^ear. Under the eye of the Super-
30 SECOND BIENNIAL REPORT
intendcntof ITenJth, tliere is far more probability of thorough
inspection, and this officer, by terms of the law l)eing a phy-sician
f^elcc'cd for the pur])Ose, his knowledge of sanitation
must exceed that of the average jury, and be more effectual
than the employment of various physicians.
The terms of the law seem mandatory enough. (Sec. 5),
" There shall he an auxiliary board of health in each county
of the State," not leaving it to ihe opinion or preferences of
county officials whether or not these boards shall be organ-ized.
This organization, where it has been effected, has
elicited a growing feeling of confidence, and surely those
counties having such an organization, are laying valuable
foundation against the probable evils of invasion by pesti-lential
disease. No county is so remote now that it may not,
in a few years, be put in communication with the current
of restless travel by the construction of railroads, and to
meet those demands of an exacting civilization, organization
must be b< gun.
Organization has another important merit; it enables coun-ties
to study their own condition as to the prevalence of
diseases, death rates, causes of sickness, and also to build up
records upon which to found a definite opinion of the favor-able
progress or decline of the sanitary condition of the
people. This has now a practical bearing and will have in
the future much more, as the tide of population turns towards
our State seeking homes, these records must be forthcoming,
figures of climate record, death rate, sickness rate, bearing
official authority will be sought after by such seekers. It is
in vain that we speak in glowing terms of our healthfulness
and api^eal to the oldest inha])itant for the salubrity of the
-climate, if we have nothing more definite to show strangers.
\\'e ki ow our advantages, but they remain to be convinced.
Penitentiary Convicts.
During the year reports had been made monthly to the
NORTH CAROLINA BOARD OF HEALTH. 31
President of this Board by Dr. James \V. McGee, physician
to the Penitentiary, and such suggestions from time to time
are made as seem to be indicated. The Board of Health
has worked harmoniously witli the authorities in this
matter, and we trust, with advantage to the State.
Insane Asylum.
Durino-the year a committee visited the Western Insane
Asylum at the request of the Board of Directors of that Insti-tution,
and their rei)ort is on tile. An invitation has been
extended the Board to visit the Eastern Asylum for the Insane
at Goldsboro.
For the first time in the history of the Board, the manage-ment
of all the public institutions have shown their appre-ciation
of the work of the Board of Healtli, and have asked
their inspections and counsels based thereon.
Improvement in County Public Buildings.
Since the beginning of the publication of the "Bulletin,"
(1886) the most noteworthy fact has been the improvement
in the condition of jails and poor-houses. We have endea-vored
to get such inspections and secure such reports as would
give the public proper information about tlie condition of
prisoners and wards of the counties. Tins has been the burden
of our endeavors from the inauguration of the Board, and,
while we do not claim tluu all of these improvements have
been brought about by the efforts of the Board, we are satisfied
that what has been done has reached the ear and consciences
of the jiublic in a proper way, and that much of tliis fruit-ful
result is due to our endeavor.
32 SKCONT) lUKNXIAL KKin)i;T
ExKcrTlVK POWKR Ol GHT TO BE BkSTOWKD I'PON THE
Board in Certain Cases.
The attitude of the State and County Boards of Health
is advisory. In all the work done by either, these bodies
must wait to be consulted by county or State authorities
or give advice gratuitously, [n the latter case the Boards
have been obliged to depend upon the force of public opinion
to reach the constituted authorities, or, if the public feeling
were apathetic, see such advice meet the fate of all gratuitous
advice—rejected and contemned. Some little executive
power can sometimes be exerted when the Supeaintendent
of Health works in concert with municipal authority, in
enforcing health ordinances already framed by towns and
cities, but this is only secondary, and the judgment of an
educated Superintendent of Health can be disregarded or
opposed by a municipal officer and place the Board of Health
in the attitude of indifference. There are certain conditions
where the Board of Health should be clothed with executive
power, and these conditions should be carefully studied and
incorporated in a l)ill to be presented to the Legislature,
after having been carefully put in legal shape by a good
lawyer. There are times when the authority of the Board
of Health of counties should be supreme. There are times
of public danger when none can be found at their posts but
the few sentinels, too humble, when the security of health
reigns, to be clothed with authority, but too valuable to be
treated with indifference—men who are not afraid "for the
pestilence that walketh in darkness, nor for the destruction
that wasteth at noonday.'"
Vital Statistics.
A system of the registration of births, deaths and mar-riages,
including also the numerical details of the. occur-
NORTH CAROLINA BOARD OF HEALTH. 33
rence of diseases daDgerous to the public health, will be a
necessity of the near lutnre. It is not only expensive work,
but in order to be accurate, must be conducted by those who
have mastered the details of the work, as well as the under-lying
principles. It maybe that the people are not read}- yet
to establish the work, and it may be as well, until the State
can secure the services of trained officials. The demand of
the times is steadily in this direction. The restless popula-tion
of this great country is turning here and there for un-occupied
lands upon which to establish homes, and they
seek information u|ion the subject of prevalence of disease
which has tiie authority of organized and authorized
registration.
The Bulletin of the North Carolina Board of
Health
Was begun in 1886, April, and lias continued its monthly
visitations ever since. It is distributed to State and county
officials, to Superintendents of Health, and to any person
asking for it. Its objects are several:
1st. To put on record the condition of health, the pre-vailing
diseases among the people and the domesticated
animals in all parts of the State, serving as a means of inter-communication
by which counties can compare their con-ditions
of sickness with each other.
2d. To give the numbers of paupers and prisoners in each
county, and to show their sanitary condition and surround-ings,
and also their educational condition, as far as their
ability to read and write.
3d. To give the numbers of deaths, and the principal
causes of death, in the larger towns in the State.
4th. To give the record of temperature and the barometer
from principal divisions of the State.
The Board considers this pioneer work, from which they
hope to educate the people up to the necessity of accurate,
3
34 sKcoxD nn;xNiAi. uiiroirr
vital statistics. Accuracy cannot be expected as the county
boards are organized, as the .SupcrintiMidenL of Health can-not
require the physicians in the county to report to him
—
their aid bein^ vohmtary, it is generally uncertain. The
only report be is able to make is such as he, by diligent
inquiry, can collect, and hence ninst be stated only in gene-ral
terms.
The time has come when all the towns in the State, num-bering
500 or more, should make a record of deaths and
births. The reports now sent in from 12 to 14 towns is
voluntary, but mostly accurately founded upon the record
obtained by compulsory certificate of death. It is to be
hoped that the General Assembly will give us a law requiring
such record to be kept.
The following suggestions are offered :
1st. No person should be allowed to be buried in any
public or private burial ground without the certificate of a
regular physician, or an affidavit of the reason why it is not
possible to get a physician's certificate, and this affidavit
must be acceptable to the Superintendent of Health of the
county.
2d. These certificates should be sent to the County Super-intendent
of Health, and by him registered in a book to be
furnished by the State Board of Health.
3d. A failure to secure a certificate of death which is
.satisfactory, should render the necessity of a coroner's inquest.
4th. All infants born should be reported within a week of
their birth to the County Superintendent of Health, under a
sufficient penalty tor failure to report The duty of report-ing
might, devolve upon the nurse or physician. A record
of the births should also be kept by the County Superinten-dent
of Health and be by him reported as u.sual to the Sec-retarv
of the State Board.
NORTH CAItOI.IXA BOARD OF HEALTH. 35
NOTIFK'ATIOX OF PESTILENTIAL Dl EASES.
It is desirable that a law should be enacted to compel
physicians and householders to report small-pox, diphtheria,
scarlet fever, yellow fever, measles, cholera, or other diseases
which are known to be capable of multiplying and threaten-ing
the public health.
There are some good reasons : The concealment of most
of these diseases makes it possible for unwary or curious
people to rush into danger; also concealment usually means
confinement in dose quarters which is detrimental to nearly
every disease of this character
Isolation of such cases and cautionary'- guarding offers the
best means of defense for the communit3^
The only way to get help from the State Board of Health
and from the contingent fund held subject to the order of
the Governor, is prompt notification of the facts to the Sec-retarv
of the State Board.
The concealment or misrepresentation of dangerous or
pestilential diseases has been the prolific source of their
spread, and it should be classed with the criminal offences
against the State.
Garbage Destructiox by Burning.
One of the questions involving the cleanliness and health
of our towns is the disposal of garbage. Garbage includes
all the dry trash and cast-off household articles, the refuse
of the kitchen, the contents of privy sinks. The old and
slovenly ways which have been in vogue for years consisted
in casting the dry garbage to the waste land in the suburbs
of towns, or to fill up gulleys and wet places with it, thus
sowing seeii for future repentance. The night soil was, and
is carried to a short distance from habitations and deposited
in shallow trenches. Slovenliness has been the characteristic
36 SECOND BIENNIAL REPORT
of lliis disposition of the ivfuse of towns and disease and
noisome odors have marked tlie places of these deposits.
Various plans have been at(emi)ted by some of the more
careful ami pros})erous towns, but none have been entirely
satisfactory.
We have at last come to a period in sanitary history when
the attempt is being made to destroy garbage by burning.
Several 3'ears ago this Board published a pamphlet showing
the necessity and possibility of garbage disposal by burning,
illustrating it with one of the furnaces erected at the time.
Many points of failure marked the earlier apparatus, but
the development has been gradually growing forward to a
stage of comparative success.
At the last meeting of the American Public Health Asso-ciation,
one of the prominent subjects was the cremation of
garbage. The announcement of the topic brought togetlier
the inventors of the furnace, with their apparatus for exhi-bition,
and a number of sanitarians from the chief cities and
towns in the United States and Canada. Practical exempli-fications
of the working of the crematories, and a full
description of the development of the process of cremation of
garbage from the earliest incej^tion of the pro -ess, were
brought before the Association. The North Carolina Board
had representatives to witness these processes in the persons
of Dr. H. T. Bahnson, of Salem, and Dr. Thomas F. Wood,
of Wilmington.
We will give a description of these crematories, giving
only those which appear to us to have present practical
value, beginning with the Eagle cremator, one of which is
in working order in Des Moines, and another recently erected
in Milwaukee.
On our way to Milwaukee w^^e stopped at Chicago, and
through the courtesy of Dr. DeWolfe, the able health officer
of that city, we saw in operation the garbage furnace erected
in the outskirts. The garbage is brought from all parts of
.the city, and landed upon a platform above the furnace, it
NORTH CAROLINA BOARD OF HEALTH. 37
being erected in the bed of a stone-quarry, and the garbage
is dumped into shutes, which land it at the furnace doors.
This garbage consists of everything usual to the refuse of a
large city, except night soil. An examination of the process
showed that it was only partially successful, as the smoke
was not burnt up, and the chimney emitted bad odors,
which would bring loud complaints in a population denser
than where this was located.
The desiderata, though, in regard to the destruction of
garbage, are its complete reduction to harmless residue, and
the avoidance of the noxious odors in the process. This the
Engel furnace accomplishes.
By reference to the cut, it will be seen that the forward
end is towards the left. " The upper door shown in the
left hand end opens into the fireplace, and the door imme-diately
below opens into the ash pit thereunder. The five
larger openings shown on the side of the furnace midway of
its length, open into tlie ash p t under the grate, which
supports the garbage and other wet and offensive substances
which are being burned. Five smaller doors above open
into the garbage fireplace in order to give easy access thereto
in case it becomes expedient to stir or otherwise move the
garbage in the fireplace while being consumed. There are
also openings in the rear fireplace, and into the pit under it.
Three angular valve handles operate the three valves which
appear in the figure to the left of the rear fireplace. The
two valves which appear in the figure give egress into the
chimney from the first fireplace and the second fireplace
respectively. The three covers on the top of the furnace
close the downward openings in the top furnace, through
which the matter may be dumped u{)on the grate. (See
figure 2.)
Figure 1 gives the perspective elevation of the furnace.
(See figure 1.)
From what we could gather, several of the best patterns of
these crematories were about to be consolidated into one im-
38 SECOND BIENNIAL REPORT
proved furnace, which would probably fulfill the demands of
the service required, and that it would be a fair estimate to
make that a furnace lar^e enough to consume the garbage
of a town of 20 000, probably including the night soil, could
be built for $3,000. The expense of operating would depend
on the cost of fuel.
Another form of the garbage crematories is a domestic
one, which is adopted for the burning of the refuse of the
household, including chamber lye. It is being adopted in
some cities with a good deal of satisfaction, and by experi-mental
demonstration we can say that it is worthy of exten-sive
trial.
The mode of operation is as follows : The garbage and matter to be
consumed are dumped upon the garbage grate, and a fire of coal 's made
in each of the two fireplaces at the respective ends of the furnace. The
flames from the rear fireplace pass over the garbage, driving before them
the steam and other gases arising therefrom into the flames above the
forward fireplace, where the flames from the two furnaces meet and
mingle. As those mingled flames pass backward toward the chimney,
they intensely heat the iron floor of the garbage ash-pit, and that
floor conducts heat upward toward the garbage above it, and thus
aids in volatilizing the liquid constituents thereof. This operation con-tinues
until the substances on the garbage grate are reduced to a dried
condition, when the lower chimney-valve may be closed and the ujjper
chimney-valve opened ; and thereupon the flames will pa^s from the
forward fireplace above the garbage-grate, and ignite the dried sub-stances
resting thereon, and drive the products of the resulting com-bustion
into and through the flames above the rear fireplace.
The question'^of economy, so far as the best use of the
refuse of cities is concerned, is not considered in the Engle
crematory desciibed above, but only that economy which
puts refuse matter into a harmless condition. For small
towns this question is not an urgent one, the number of
dead animals to be burned not being great enough to make
it worth while to separate the fat, hides, hoofs, &c., but in
the larger cities it is a question which will be settled, as it
has been in a crematory erected at Buffalo.
XORTH CAKULINA BOARD OF HEALTH. 39
7- KEPOKT
The following (lt'^ci'i{)tiuii of the crematory erected at
Buffalo, New York, known as the Vienna Garbage Process,
I take from the Sanitary News, of 2r)th December :
It consists of a large cylinder or boiler, called the dryer. This is inside
a lari;er bodj' of tlie same shape, leaving a large opening bet%veen the
two boilers. When the inner cylinder is filled with garbage, the cap is
put on the man-hole of the outer one, and steam at 250" Fahrenheit is
turned on in the open space. The garbage is submitted to the cooking
process for s-ix or eight hours. The vapor generated by the heat, and
acting upon the liquid portion of the stuff, is forced out and into a
column still containing peiforated plates and filled with cold w-ater.
The condensation is rapid, and it passes away from the dischai"ge-pipe
in the shape of cool and entirely colorless water, having the odor of
water in which vegetables had been boiled. The garbage is carried by
elevators from the dryers to the floor above, where it is dumjjed into-vats,
called extractors. When filled, the vats are covered with iron
plates, and benzine and other chemicals are turned into it from another
vat. This and the steam heat, which is again turned on, separates the
oil and grease from the garbage, the former being drawn off at the
bottom of the vat. It resembles crude petroleum, and has little or no
odor. The garbage is then taken from the vats and conveyed to another
dry-room with thin iron plate fiooi-. By this time the substance is
reduced to about the consistency of ground tan- bark, and is odorless. It
then meets with a ready sale to fertilizers. The furnace has a capacity
of forty-five tons of garbage per day. The inside of the crematory is
not at all offensive, and there is no unpleasantness about it.
What concerns its most, vaw we erect these furnaces at
small enough cost to make them available Ibi' small towns,
where economy is a i)ara mount object? do these furnaces
really destroy without ollen.^ive exhalation? We believe
the answer to botii c^uestions can be given in the affirmative.
The Sl.\ugiitering of Animals for Food.
There is not in the iState any law, either general or local,
which gives to the consumer any security that the animal
food offered in our markets i.s in proper condition, and there
is no greater (huiger in communicating some forms of dis-ease
than by ill-conditioned meat. The description of the
XOKTH CAROLIXA KOAI.'D (»F HEALTH. 41
42 SECOND BIENNIAL REPOKT
usual processes of slaughter and preparation clone in some
of our towns would disgust most |)ersons with the beef and
mutton they eat, and [loik would have to be rejected as
absolutely rei)u]sive. Piovisioiis against such abuses would
be forced by the public, if it were the fashion of our news-paper
men to "write u|i'" tlie condition of our slaughter
houses with the same ^
pi!
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NOKTH ( AROLTNA BOARD OF HIiALTH. 47
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NORTH CAEOLIXA BOAED OF HEALTH. 51
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NORTH CAROLINA BOARD OF HEALTH. 71
MORTUARY REPORT FOR AUGUST, 1888.
FROM FOURTEEN TOWNS.
Causes of
Death.
72 SECOND BIENNIAL REPORT
MORTUARY REPORT FOR SEPTEMBER, 1888.
FROM FOURTEEN TOWNS.
Causes o
Death
NORTH CAROLINA BOARD OF HEALTH. 73
MORTUARY REPORT FOR OCTOBER, 1888.
FROM THIRTEEN TOWNS.
Catjses of
Death.
74 SECOND BIENNIAL REPORT
MORTUARY REPORT FOR NOVEMBER, 1888.
FROM FOURTEEN TOWNS.
Causes of
Death.
Typhoid fev'r
NORTH CAROLINA BOARD OF HEALTH. 75
MORTUARY REPORT FOR DECEMBER, 1888.
FROM FOURTEEN TOWNS.
Causes of
Death.
76 SECOND BIENNIAL REPORT
TEMPERATURE REPORT FOR JANUARY, 1887.
NORTH CAROLINA BOARD OF HEALTH. 77
TEMPERATURE REPORT FOR MARCH, 1887
78 SECOND BIENNIAL REPORT
TEMPERATURE REPORT FOR MAY, 1887.
NORTH CAROLINA BOARD OF HEALTH. 79
TEMPERATURE REPORT FOR JULY, 1887.
80 SECOND BIENNIAL REPORT
TEMPERATURE REPORT FOR SEPTEMBER, 1887.
NORTH CAROLINA BOARD OF HEALTH. 81
TEMPERATURE REPORT FOR NOVEMBER, 1887.
82 SECOND BIENNIAL REPORT
TEMPERATURE REPORT FOR JANUARY, 1888.
NORTH CAROLINA BOARD OF HEALTH. 83
TEMPERATURE REPORT FOR MARCH, 1888.
84 SECOND BIENNIAL REPORT
TEMPERATURE REPORT FOR MAY, 1888.
NORTH CAROLINA BOARD OF HEALTH. 85
TEMPERATURE REPORT FOR JULY, 1888.
S6 SECOND BIENNIAL REPORT
TEMPERATURE REPORT FOR SEPTEMBER, 1888.
NORTH CAROLINA BOARD OF HEALTH. 87
TEMPERATURE REPORT FOR NOVEMBER, 1888.
88 SECOND BIENNIAL KErOKT
TABLE SHOWING CONDITION OF JAILS FOR YEAR 1887, IN
THE COUNTIES REPORTING TO THE STATE
BOARD OF HEALTH.
COUNTIE;-
Alamance
Alexander..
Ashe
Beaufort
BriHi.swiek.
Bunco 1 be
.
Burke
Cabarrus ....
Catawba
Chatham....
Cherokee ..
Cleveland...
Columbus..
Cumberland,...
Davidson
Duplin
Durham
Edgecombe.. ..
Forsyth
Franklin
Gaston
Greene
Henderson
Guilford
Iredell
Johnsion
Jones
Lenoir
Lincoln
Macon
Madison
McDowell.
Montfiomei J'... New Hanover
Nortliampton.
Pender
Pitt
Richmond
Robeson
Rowan
Rutherlord
Sampson
Stanly
Swalh
Tyrrell
Transylvania..
Union
Vance
Wake
Warren
Washington
Watauga
Wayne
Yancev
Number of Pi isoners con-fined
during
121 IS
6 6
5 5
4 4
'l\ 1
1115
8
...113
2. 7
7!lb
3 3
4
25
15
12 1
4| 4
» b
5 1U
3 4
1 5
7 i
1117
2 2
lb
10
3
1210
10
2
7
3
13
29 10
15 24
12 30
16
4
4
4
fi
2
24!36
10
Ave at;e
nunil>pr
14
10
7
5
8
2
K
17
IS
5
7
3
8
25
21
9
11
5
f>
4
ci:
^" 2c
5
742
629
165
General Remarks
on wanitary
condition.
1,491
1,256
1,555
9,45(1
2,851
585
2,497
800
1,83
1
588
1,115
440
l,08ti
1,780
842
6.S7
781
585
904
2,093
287
1,473
502
544
627
600
531
1,160
1,414
694
1,235
856
1.220
1,100
559
1,100
1,368
2,152
2,152
950
400
As good as the build-ing
will permit.
Better.
Building a jail.
No report.
Not good.
Good.
No report.
Good.
Good.
Very good.
No improvement.
Good.
Clean and properly
disinfected.
First-class order.
Good.
Good.
Good.
Not good.
Very good.
Good as can be obt'd.
Good.
Very good.
Very good.
Fair.
Very fair.
Very good Indeed.
Good.
Good.
About as usual.
Good.
Good.
Good.
Fair.
Rxcellent.
Good.
Not > et completed.
Not good.
Good.
Fair.
Pretiy good.
Very good condition.
Good.
Pretty good.
Not very good.
Good.
Excellent.
Bad.
Good.
N eeds a more unifom
heat.
Very good.
Ordinary.
Bad.
No report.
Not good.
NORTH CAItOLIXA BOARD OF HEALTH. 89
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90 SECOND BIENNIAL REPORT
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NORTH CAROLINA BOARD OF HEALTH. 91
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94 SECOND BIENNIAL KEPOKT
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NORTH CAROLINA BOARD OF HEALTH. 97
REPORT ON THE SANITARY CONDITION OF THE
WESTERN INSANE ASYLUM.
To the Board of -Directors Western N. C. Insane Asylum,
Morganton, N. C:
Gentlemen :—The undersigned, members of a committee
from the N. C. Board of Health, appointed by President
Jones, at the request of the Superintendent to visit your
institution, would respectfully report. We reached Morgan-ton
July 28th, and spent part of that day and of the next
at the Asylum, considering the following subjects, upon
which Dr. Murphy desired our opinion
:
1st. The amount of water supply.
2d. The dietary list, the amount, quality and mode of
preparation of the food furnished to the patients.
3d. The propriety of using the sewage of the institution
on its garden.
4th. The difference between painted and unpainted walls,
looked at from a sanitary point of view.
1. The Amount of Water Supply.
In regard to the facts, we were compelled to accept the
statements of the Superintendent, but we have no hesitation
in expressing our perfect confidence in their trustworthiness.
We learned from him that the total amount of water deliv-ered
at the Asylum through the supply-pipe from the moun-tain
in 24 hours, was about 275 gallons per patient, more
than enough, but that owing to the fact that there was no
provision for storing any part of it, for that purpose, only
about half of it could be utilized, or so much of it as was
delivered during the waking hours of the institution. In
consequence, during certain hours of the morning, when the
98 SECOND BIENNIAL REPORT
draught upon the supply was greatest, the pressure was so
much diminished that water could not be obtained above
the second floor.
We regard water in the greatest abundance easily acces-sible
at all points and at all hours as of the highest impor-tance
in the proper management of all hospitals, more
especially those whose patients, on account of the nature of
their complaints, are unusually filthy. We would, there-fore,
respectfully recommend that as soon as it can be ar-ranged,
storage for the water, at present running to waste,
sufficient to keeping full pressure in the pipes at all times,
be provided.
2. The Dietary List, &c.
We inspected the list, catechised the Steward on the sub-ject,
visited the kitchen, examined the dinner, the cooking,
and talked with the housekeeper. In our opinion, the diet
is sufficiently varied, excellent in quality, well prepared, and
so far as we could judge (without a residence in the institu-tion
for a considerable time), ample in quantity.
3. The Propriety of using the Sewage on the
Garden.
We think it inadvisable. Dr. C. W. Chancellor, " Secre-tarv
of the Maryland Board of Health," in his admirable
report on Improved Methods of Sewage Disposal, &c., 1887,
says : " The saturation of the soil in or near a town, by crude
sewage matters, is a constant concomitant of epidemic dis-eases
; while a proportionate exemption from such maladies
has followed the removal of this source of terial pollution."
* * " The sewage, cleared of its solid matter by deodorizing
and precipitating agents, may be used for fertilizing pur-poses,
but even this purified liquid, if allowed to stagnate
in large quantities on the surface, would, as in common
NORTH CAROLINA BOARD OF HEALTH. 99
irrigation, be likely to engender disease." Another reason
against such an application of the sewage, which occurs to
us, is that the appetites of nearly all invalids, more especially
the insane, to whom the digestion and assimilation of a
sufficiency of good food is of peculiar importance, is noto-riously
capricious and uncertain, and should it come to the
knowledge of your patients, as it would of course, that their
vegetables were largely the product of their own excrement,
their appetites would be still more impaired. Finally, owing
to its very great dilution, its profitable use would be exceed-ingly
problematical.
4. The Hygienic difference between Painted and
Unpainted Walls.
It is always desirable that hospital walls, or those of any
apartment habitually occupied by sick people, should be of
such a character as to absorb as little as possible of the
effluvia constantly emanating from the patient. As painted
walls have less power of absorption than hard finished, we
think them preferable ; but we can see no necessity for
painting the walls of the Asylum, which are unusually good
at present, though we would recommend that paint be applied
when they need overhauling.
In conclusion, we desire to express our appreciation of the
kindness and hospitality of Superintendent Murphy.
RICHARD H. LEWIS, M. D.
HENRY T. BAHNSON, M. D.
100 SECOND BIENNIAL REPORT
REPORT ON THE SANITARY CONDITION OF THE
EASTERN N. C. INSANE ASYLUM,
BY DR. J. H. TUCKER, AND J. L. LUDLOW, C. E., M. S., COM-MITTEE
APPOINTED BY THE NORTH CAROLINA BOARD
OF HEALTH AT THE INVITATION OF THE
EASTERN ASYLUM FOR THE INSANE.
Raleigh, N. C, July 21, 1888.
To the Superintendent and Board of Directors,
Eastern Insane Asylum :
Gentlemen :—In accordance with your invitation, and
under instructions from the office of the Secretary of the
State Board of Health, we would respectfully state, that on
the 27th of June we made a careful sanitary inspection of
the Institution over which you preside, and beg to submit
herewith the following report
:
We note with pleasure the present excellent health of the
Asylum, and its exemption from epidemic diseases of all
kinds for the past twelve months. When it is remembered
that dysentery and diarrhoea have prevailed in epidemic
forms throughout Eastern Carolina, and to some extent in
the immediate vicinity of the Asylum, we are obliged to
believe that the immunit}'' enjoyed is the result of constant,
vigilant and intelligent enforcement of the sanitary rules
and regulations which seem to prevail in ever}'^ department
of this Institution.
The wards, dormitories, mess-halls, closets and pantries
were found in good order and scrupulously clean, every-where
showing the effects of soap and water properly and
vigorously applied. The air space in the dormitories is abun-dant
(750 cubic feet space per capita being the allowance),
NORTH CAROLINA BOARD OF HEALTH. 101
and, with the exception noted under the head of ventilation
there was an absence of all unpleasant and disagreeable
odors. The beds, bedding, sheets and coverlets were neat,
tidy and admirably adapted to the purpose for which they
are designed.
The grounds and yards are in a good sanitary condition
The superficial drains are all open, no accumulation of gar-bage,
no standing water, and the entire premises showed
evidences of constant and systematic attention.
The patients were neatly and comfortably clad, and their
appearance indicated clearly that all proper rules of personal
hygiene were rigidly enforced. While it does not come
properly within the scope of this report, we cannot forbear
to sa}^ that the health authorities of the State can render
these poor, unfortunate people no greater service than to
strongly impress upon the county authorities the importance
of early hospital treatment for the insane. These people,
especially, come from the poor and more dependent of our
inhabitants; they are found in their own homes in condi-tions
of utter destitution, often suffering for the bare necessi-ties
of life ; or else they are found in work-houses, poor-houses
or jails, without treatment of any kind, and are physical as
well as mental wrecks.
It is confidently believed that earlier recognition of insan-ity,
with prompter efforts at treatment, will enable this Insti-tution
to show a greatly diminished death rate and a much
more gratifying percentage of recoveries. We would respect-fully
commend this matter to the serious consideration of
all persons who are in any way connected with the manage-ment
and care of the insane throughout the State.
The kitchen was found in fairly good condition, the uten-sils
were in good order and clean, but showed evidences of
wear. The range is also much worn and is too small to
meet the requirements of an Institution of this size. We
recommend its condemnation, and the substitution of one
of larger capacity and more approved pattern. To this
102 SECOND BIENNIAL REPORT
should be added two or three large boilers of sufficient size
to supply the Institution with soups and stews.
We were permitted to examine the bread (both corn and
wheat), which was found to be of excellent quality, whole-some
and palatable; indeed, the entire dietfiry, so far as we
were advised, is sufficient in quality, quantity and variety,
to meet all the requirements of health.
The ice supply seemed inadequate for the needs of the
Institution, and there was no provision for preserving fresh
meats, vegetables, fruits, butter and milk in warm weather.
Both from an economic and health stand point, we would sug-gest
the addition of a large refrigerator, with a sufficient
number of compartments to meet these important ends.
The cost of such an apparatus, when measured by the con-venience
and comfort afforded, would be trifhnf'r&.•
Water Supply.
The water supply of the Institution is from two sources,
and obtained by two distinct systems. One supply is for
drinking and culinary purposes; the other for general use
and drainage purposes.
The supply for drinking and culinary use is rain water
gathered from the roof and stored in cisterns. Such a sup-ply
is quite desirable and atfords a ver}^ excellent quality
of water—provided some precautions are taken in collecting
it. This water should be collected and stored during the
winter or rainy seasons. At various times during the year,
the atmosphere is loaded with various impurities, which
could not be safely introduced into our drinking water. During
the summer or any dry period, the air may, and usually
does, become very heavily laden with such impurities,
from particles carried in dust from the streets and roads,
from the gases of manufactories, from decomposition of
various vegetable and animal substances and other sources.
At such times the atmosphere may become contaminated to
NORTH CAROLINA BOARD OF HEALTH. 103
such an extent, that an ordinary, or at times an extraordi-nary,
rain would not sufficiently purify the air to pass any
portion of the rain water without its absorhing more or less
of its impurities. Further demonstration is not necessary
to show that it would be injudicious to collect rain water at
such times for drinking or culinary purposes.
In the autumn season also, when so much of nature is in
a state of death and decay, great care and limitation should
be placed upon the collection and use of rain water.
During the winter and spring when rains are much more
frequent and copious, the atmosphere is little likely to
become dangerously contaminated. It is then in its most
pure condition, and there is little danger of collecting evil
impurities with rain water stored at such times, hence these
are the seasons when these supplies should be obtained.
Before storing rain water at this time, however, one precau-tion
is quite necessary, the rain should be allowed to con-tinue
for a few moments to wash the roof of all substances
which might be collected and (deposited there, before the
water is turned into the cistern. It gives us pleasure to state
that we were informed by the authorities that these observa-tions
have been and are largely practiced, and we therefore
feel assured that the supply is a very wholesome one. A
further and ver}' desirable purification they also obtain by
passing the water from the storage tanks through a charcoal
filter before it is used.
The water which is used for general purposes and drain-age,
is pumped from the river flowing near by to elevated
tanks, giving a sufficient head to distribute the water
throughout the institution. Hose connections are main-tained
with these tanks for use in case of fire. This supply
is seemingly adequate for all demands and is of ver}' fair
quality.
104 SECOND BIENNIAL REPORT
Drainage.
The drainage system we do not find in such favorable
condition as the water supply. In its design and construc-tion
various errors have been made, the results of which
might reasonably be expected to prove serious. While the
evils which will be mentioned have not as yet apparently
caused any serious results, as far as we could learn, yet they
are disease tempters, and should be remedied at once, ere
the good record of the drainage system be completely de-stroyed.
The house drains of the sewerage system are located in
ditches or tunnels excavated beneath the building. These
tunnels are at right angles to each other, one extending the
entire length of the building, the other intersecting this
from one side. They are provided and used for carrying all
the service pipe of the building to the various distributions.
The ventilation of these tunnels is very defective, and will
be discussed more fully under the general head of ventila-tion.
The sewer pipes in these tunnels are buried to a slight
depth and located so that iron soil pipe extensions are
made from these to serve the closets in the various wards
in the institution. These iron soil pipes are of proper size
and extend to the roof of the building ; on each floor, pan
closets are connected with them, as well as bath tubs and
wash bowls ; kitchen and pantry sinks are also connected
with these pipes. These service connections are in many
cases in very bad condition ; some are not trapped at all, and
others very imperfectly trapped. All these connections
should have a thorough remodeling and be put in perfect
condition, as well as be provided with ventilating facilities,
which will be further spoken of in what follows.
The iron soil pipes from the bath rooms, closets, &c., are
carried to a terra cotta pipe in the tunnel, spoken of above
NORTH CAROLINA BOARD OF HEALTH. 105
this pipe continues to the outside of the building. From
this point to the outfall at the river bank, there is a fourteen
inch sewer pipe; at the outfall, provisions for carrying off
the sewage rapidly had been neglected, but upon our recom-mendation,
the Superintendent gave orders to have it reme-died
immediately.
The pipes are too large for the service required, and the
system as a whole has very inadequate and imperfect venti-lation,
the evil effects of which itself is further aggravated
by the excessive size of pipes.
Earthenware pipes should never be used in the construction
of soil pipe in any drainage system, and in the case of these
tunnels, though these pipes are buried, there is yet a possi-bility,
and, indeed, a great probability, of sewer gas escaping
from imperfectly made joints, and forcing its way through
the slight covering of earth over them ; such a case would
be very much aggravated here on account of the slight air
space in the tunnels and their imperfect ventilation ; that
there was such escaping sewer gas was too evident at the
time of our visit by the odor of the air in the tunnels and
in the corridor of the first floor above. These earthenware
pipes beneath the building should at once be replaced
by cast iron pipes, with carefully made lead joints, and fre-quently
tested for leaks and imperfections. This is especially
necessary when it is considered that the air from these tun-nels
is directly communicated to the wards and corridors of
the building under the existing state of affairs ; recommen-dations
regarding the change of this will follow in this
report. '
The sewer from the building to the river is unnecessarily
large, but it will not deserve serious criticism if frequently
and copiously flushed, and the following provisions for ven-tilation
are put in effect
:
Thorough ventilation of the system should be provided,
first, by constructing at least three (more would be better)
ventilating shafts along the sewer from the building to the
8
106 SECOND BIENNIAL REPORT
outfall, one of which should be placed near the outfall, one
about midway to the building, and one near the building
where the fourteen-inch sewer begins. The first two may be
simply a piece of pipe or brick chamber extended from the
pipe to the surface or high water mark, and provided with
open covers.
The ventilator near the building should be a brick and
cemented chamber, with bottom concentric with the out-flowing
pipe. All soil pipes and waste pipes should be led
to this chamber. It should be of itself sealed from the
external air, except by a ventilating pipe of three-inch cast
iron, which should be carried from the chamber to a few
feet above the top of the building, remote from any window
or chimney. All inflowing pipes of this chamber should
be provided with a running trap, ventilated on house side
to ventilating pipe, just before entering the chamber. This
will provide for good ventilation of the sewer itself and
prevent any gases which may accumulate therein from enter-ing
the pipes within the building.
For the ventilation of the soil pipes, further provision is
also necessary. The soil pipes, extending as they do to the
roof of the building, will, in some circumstances, serve as
ventilators, as they were evidently designed to serve, but
when they are filled with water in an upper story, ventila-tion
is completely cut off for all floors below, and the solid
column of water rushing down the pipe tends to force the
traps on the lower floors, if not otherwise ventilated, rather
than to permit the pipe to serve as a ventilator. It is during
a rain, however, that the existing arrangement displays its
weakness and inadequacy. At such a time when rain from
the roof is running down the soil pipes, as we were informed
it usually does, the air and gases in the pipes are under the
greatest compression, hence the greatest need for an oppor-tunity
of its escape. But just at this time, the pipe is run-ning
full of water and there is no avenue of escape, except
to force the weaker trap or traps along its path. In brief,
NORTH CAROLINA BOARD OF HEALTH. 107
at the time ventilation is most needed, it is the least pro-vided.
To remedy this, there should be a two-inch cast iron
pipe extended along but independent of the soil pipe to a
few feet above the roof, this to serve as a ventilating pipe
only, and all traps and connections should be ventilated
through this pipe.
The pan closets in use are probably as good provision as
can be made for people of this class, but their frequent flush-ing
should never be neglected. In connection with these
closets however, we found a great evil to exist in the floors
of the rooms in which the closets, wash sinks, bath tubs, etc.,
are located. With this class of people especially, it is emphati-cally
necessary that the floors should be made of some non-absorbing
material, such as slate or tiles, as wood floors are
apt to occasion much evil by absorbing various impurities
consequent upon such places.
*
HEATING.
The building is heated by steam radiators distributed
about the various corridors. While we do not approve of
this method, it is yet one of the standard methods of heating,
and we would reserve comment, except to say that we deem
it urgently desirable that the steam conducting pipes which
are suspended in the tunnels should be wrapped or covered,
as very much heat is lost and unnecessary fuel consumed on
account of the exposed portion of the pipes.
In suggesting the improvement of the heating system, we
must preface our recommendations by observing that the
present method serves only to heat and reheat and keep
heated the same air, after being breathed and fouled and
breathed over and over again, until it is laden with an
enormous and extremely dangerous excess of carbonic acid
gas; we cannot see how it can be otherwise in the cold
season, when we were informed by the authorities that it is
next to impossible to keep any windows open on account of
108 SECOND BIENNIAL REPORT
the inclinations of the patients to keep off every encroach-ment
of cold air and the existing ventilation being insuffi-cient
to overcome this difficulty.
Our recommendation for the improvement of the heating
method is that in addition to the existing steam system, a
heated air system be adopted. Detail plans for such a sys-tem
would embody, provision for drawing air from the
external atmosphere remote from any possible contamina-tion,
heating this air by passing it through a suitable furnace,
conducting it throughout the building by the existing flues
and such other ducts as might be required, and finally, when
this air has served its mission by warming and being
breathed, that it be conducted by other flues to the top of
the building and returned again to the external atmosphere
at such a point or points that it will not again be returned
to the furnace. This system would serve the double purpose
of supplying fresh air as well as heat. The two systems
could be operated in harmony after a little experimenting
to determine the relative amounts of heat to be supplied by
the hot air furnace and the steam boilers in order to furnish
sufficient heat and pure air to the inmates of the Institution.
The adoption of these plans would very greatly simplify and
aid materially in the adoption of the recommendations under
the following subject of ventilation.
VENTILATION.
The ventilation of the Institution is defective and to be
condemned. It consists of a system of flues extending from
the tunnels before spoken of to the attic of the building,
with openings to the difterent wards and corridors along
their course, and terminating in the attic instead of directly
into the external air. The air of this attic is drawn out by
ventilators above the roof. The fresh air supply is taken
from the tunnels ; these are insufficiently supplied from the
external air by the openings at the ends and by several
NORTH CAROLINA BOARD OF HEALTH. 109
small openings beneath the floor at the top of the tunnel.
As stated before, the air of these tunnels is very foul and
very unfit to be supplied to the building for fresh air, the
case is quite similar to ventilating a dwelling house by taking
the fresh air supply from the cellar, which is severely to be
condemned.
To improve the ventilation, we recommend the following
The air in the tunnels beneath the building should first be
purified by furnishing a greater supply from the outside, and
by replacing the terra cotta house drains by cast iron of suffi-cient
weight and strength to admit of caulking the lead
joints, so as to make them water and gas tight. The fresh
air supply for the wards and corridors, should be obtained
directly from the external atmosphere b}^ some standard
approved method, and the supply should be so adequate
that it can at all times be mechanically regulated to suit the
requirements for proper displacement. This air should be
supplied directly to the inmates by one system of flues and
carried awa}' by flues entirely separate from these. The
location of the openings to and from the flues would some-what
depend upon the system of heating which may be
applied ; with the present sj^stem of heating, however, and
the problem simply one of suppl3dng fresh air, we would
recommend that the supply flue openings be placed near the
ceiling, and the exhaust flues near the floor; this would give
a desirable circulation to the air and more completely carry
off" the impurities or vitiated air, which, being heavier than
the pure air, would be more generally collected near the
floor.
In closing, we would state that some of the criticism may
seem unjustly severe, and, in mitigation, we would also state
that in this report we have not considered how other similar
Institutions may be, but how this and all others should be,
from a purely sanitary stand-point.
110 SECOND BIENNIAL REPORT
CONCLUSION.
In conclusion, we beg to make due acknowledgment to
the Superintendent and his staff for the valuable aid ren-dered
in making the survey, and to return our thanks for
the hospitality extended to us during our stay at the Asylum.
Very respectfully,
Your obedient servants,
J. H. TUCKER, M. D.,
J. L. LUDLOW, C. E.
APPKNDIX.
APPENDIX
PRELIMINARY ENQUIRY INTO THE CAUSES OF DEATH IN
NORTH CAROLINA, AND SOME SUGGESTIONS
ABOUT THE FUTURE OF PREVENTION.
BY THOMAS F. WOOD, il. D.
Sanitary reformation, to be permanent, must be fovmded upon the
conviction of insanitariness, and to convince a community of insanitary
conditions we must have the figures and facts whicli have been care-fully
and honestly collected, intelligently recorded, digested, and inter-preted.
So then, we, at the very outset, meet with the difficulty, as
regards our State at large, of a lack of sufficient information of vital
statistics to make any but preliminary—but, we trust, practical—deduc-tions.
Few towns in the State have kept records of death until since the
State Board of Health was organized, with the exception of Wilmington;
and death certificates were made compulsory there in 1878—since then
Charlotte, Asheville, Durham, Fayetteville, New Berne, Raleigh, Golds-boro,
Henderson, Oxford, Washington and Tarboro.
These towns have made their work regularly, and, I believe, con-scientiously.
The county reports are deficient, and necessarily so, as the Superin-tendent
of Health, who is required to collect certain items relating to
disease and death, must rely upon the reports sent to him, and in very
few counties have physicians been able to view the matter of reporting
to the Superintendent of Health as of sufficient moment to take the
small trouble necessary.
More education of the public, more harmony among the profession,
and money to pay for the work, will one day bring about a system of
vital statistics such as that of New Jersey, Michigan, Rhode Island,
and other States. Although county reports are not founded on knowl-edge
of actual numbers of deaths, still every Superintendent has means
of knowing when any of the diseases dangerous to the public health
exist, and, in general terms, to what extent. A few reports are mere
perfunctory dashes of the pen, bearing upon their face, in the manner of
chirography, a hurried guess of the state of things. In the main,
though, one can get a pretty fair knowledge of the nature of diseases
prevalent in the State by such information as we now possess.
For convenience, let us divide the State into natural sections—after the
114 APPENDIX.
plan marked out by Dr. M. A. Curtis, the late distinguished botanist of
our State, in his* "Woody Plants of North Carolina "—into Lower, Mid-dle,
and Upper:
"A line di-awn from Blakly, on the Roanoke, in the direction of
Cheraw, on the Pee Dee, will neaily indicate the western termination
of the Lower district, although the actual boundary limit between
these two is as irregular as a line of sea-coast, which, very probably,
this once was."
" The Middle district reaches westward to the base of the Blue Ridge,"
and the Upper district all west of, and including, the Blue Ridge moun-tains.
The Eastern section is distinguished as the region of the long-leaf
pine; the Middle section as that of the oaks, and the Western, a flora,
varying with every hundred feet of elevation, including firs and ferns
and mosses and lichens. The difference of elevation between the moun-tains
and the sea-coast, according to Dr. Curtis, " occasions a difference
of vegetation equal to ten or twelve degrees of latitude." The influence
of these divisions, making a varied topography, is easier to study than
Ihe habits of life of individuals, or farmers, or hamlets, villages and
larger towns.
The study of all these influences on the career of a life must be left to
the future, and will not be complete until after studying the drainage,
ventilation, heating and water-supply, habits of cookery, indulgence in
stimulants and tobacco, and the methods of labor and intervals of recre-ation,
are patiently considered.
The population of this State is remarkable in many respects. The
white population, now a homogenous whole, has not been varied by the
influx of foreign inhabitants since the ante-revolutionary period (1775),
the foreign population being about 5,000, according to the census of 1880,
which is smaller than that of any State in the Union, except Florida.
While large numbers of our population have emigrated to Southern
States, the bulk of the population have little of that restless desire to go
prospecting in the outside world, which marks the Northern and West-
•ern people. When the war broke out the bulk of our adult population
in the army saw more of the outside world in their marches wiih the
Army of Northern Virginia than they had ever seen before, and most of
them, when they reached Carlisle, in Pennsylvania, were farther away
from home than they had ever been before, or since. Unlike other
States, we have no large city where the bulk of the population visit on
business or pleasurjB, all their patronage being bestowed on the nearest
village to them ; no metropolitan ideas of fashion or manner of living
enter into their daily life. The greatest change is in the manner of life
of the negro. EmanciiDation virtually emptied a foreign population
tino our towns; for the negro, cared for in the cabins of the master under
* Geological and Natural Survey of North Carolina: Part III.— Botany, &c.
By Rev. M. A. Curtis, D. D.
^ APPENDIX. 115
rules of strict personal government, could be commanded to do for his
well-being, while the emancipated negro considered that a home apart
from the whites was the essence of personal and political freedom—to
live in squalor, packed in small windowless rooms, to a degree that
would nauseate a white man, and drive sleep away effectually, in a con-dition
of perfect comfort; in sickness, trusting to any chance remedy
brought to him, regai-ding his disease as matter of little concern to him-self,
but as a matter demanding service from the former white master
or his present white employer—so firmly had this taken possession of his
being while a slave. Personal cleanliness was utterly neglected, except as
to the face and hands, and change of raiment; confined, in most cases,
to the putting on of fine cast-off toggery for Sunday: rushing into con-tageous
diseases with stolid indifference, and herding with each other
during epidemics with helpless fatality. SmaU-pox is a disease which
vaccination causes, in their belief, because they know that the white
people vaccinate during the prevalence of small-pox, their blind deduc-tion
being that it was the cause. Syphilis, which was rare among
negroes as slaves, became the most common of diseases. Promiscuous
herding of the sexes spreads the disease with fearful rapidity. A negro
man, applying for treatment for chancre, only desires (and he has not
improved any to this day) to be relieved of the discomfort and inconven-ience
of the local sore, regarding it only as a barrier to further indul-gence.
In all essential respects, therefoi-e, the negroes were, and are, a
foreign population, below the people of any nation in decent instincts,
and elevated from the condition of native Africans by the contact with
the whites, entirely at the expense of the latter, and as burdensome, in
many respects, as the old man of the sea was to Sinbad ; the most pa-tient
and valuable of all laborers in a hot climate; the most tractable and
easily influenced for good when segregated among the whites, but when
herding among themselves, with no light but that of their own leaders,
drifting always away from the good. A town, therefore, which has
twenty thousand inhabitants, more than half of which are negroes,
represents a lack of thrift and a lack of hygienic surroundings that
really discounts the white population. In speaking of a town of this
sort, as compared with one wholly of whites, numerical estimates are
entii'ely misleading. Th